Provider Demographics
NPI:1205831864
Name:NETZER, R. CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:R. CRAIG
Middle Name:
Last Name:NETZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4473 PAHEE ST STE L
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2037
Mailing Address - Country:US
Mailing Address - Phone:808-632-0200
Mailing Address - Fax:808-632-0201
Practice Address - Street 1:4473 PAHEE ST
Practice Address - Street 2:STE O
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2037
Practice Address - Country:US
Practice Address - Phone:808-246-2709
Practice Address - Fax:808-246-2700
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50101602Medicaid
HI50101602Medicaid
HIH65103Medicare UPIN